Phacoemulsification versus extracapsular cataract extraction in patients with diabetes

Objective: To compare phacoemulsification with extracapsular cataract surge ry in patients with diabetes and to identify determinants of postoperative visual acuity, Design: Prospective, randomized, paired-eye trial. Participants.. Forty-six patients with diabetes and bilateral cataract. Intervention: Patients were allocated to phacoemulsification surgery with s ilicone intraocular lens to one randomly determined eye, and extracapsular cataract surgery with 7-mm polymethylmethacrylate intraocular lens to the o ther. Main Outcome Measures: Logarithm of minimum angle of resolution visual acui ty (logMAR VA), incidence of clinically significant macular edema (CSME), r etinopathy progression, indices of anterior segment inflammation, and incid ence of capsulotomy. Results: Compared with eyes undergoing phacoemulsification, eyes managed wi th extracapsular surgery had more anterior chamber cells (P = 0.0004) and f lare (P = 0.007) 1 week after surgery and a higher incidence of posterior s ynechiae (P = 0.04) and intraocular lens deposits (P < 0.0005) in the first postoperative year. The need for posterior capsulotomy was greater in eyes undergoing extracapsular surgery (16 of 46 vs. 5 of 46, P = 0.01), No diff erence in incidence of postoperative CSME, progression of retinopathy, or d evelopment of high-risk proliferative retinopathy was identified between te chniques (P = 1,0, 0,8, and 0,2), Median 1 year logMAR VA was worse in eyes undergoing extracapsular surgery (0.08 vs. 0,06, P = 0,02), especially in those with retinopathy (0.14 vs. 0.08, respectively; P = 0,01), The presenc e or absence of CSME at the time of surgery was the most significant determ inant of I-year logMAR VA in regression models for both extracapsular (P = 0,0004, R-2 = 0.45) and phacoemulsification groups (P < 0,00005, R-2 = 0,46 ), Conclusions: Phacoemulsification is associated with better postoperative VA , less postoperative inflammation, and less need for capsulotomy than extra capsular cataract surgery in patients with diabetes. However, with both tec hniques, the principal determinant of postoperative VA appears to be the pr esence or absence of CSME at the time of surgery. Early intewention, reduci ng the risk that unrecognized CSME is present at the time of surgery, may b e more critical to outcome than choice of surgical technique. (C) 2000 by t he American Academy of Ophthalmology.